WavelinQ Flashcards
How long should vascular access be placed before you start dialysis?
weeks or months
The three basic kinds of vascular access for hemodialysis are
- arteriovenous (AV) fistula
- arteriovenous (AV) graft
- venous catheter
Connecting the artery to the vein causes
more blood flow to the vein
One important step before starting regular hemodialysis sessions is
preparing the vascular access
vascular access
which is the site on your body where blood is removed and returned during dialysis.
requires advance planning because a fistula takes a while after surgery to develop—usually from two to six months
Arteriovenous or AV Fistula
A surgeon creates an AV fistula by
connecting an artery directly to a vein, usually in the wrist or forearm
This method is best suited for the person who chooses to self-cannulate (inserting your own needles)
Buttonhole Technique
The most common problem with the AV fistula is a condition known as
stenosis
When the needles are inserted into your vascular access for hemodialysis
cannulation
The WavelinQ™ EndoAVF System is indicated for the creation of an
arteriovenous fistula (AVF)
Why Endo AVF?
- Avoids surgical scarring and minimizes arm disfigurement associated with open surgery
- Additional anatomical AV fistula locations
- Multiple venous procedural approaches1
Initial screening questions for EndoAVF:
- Is this patient a healthy patient?
- Is this patient not a canidate for a more distal AVF?
Who is a canidate for EndoAVF?
surgical AVF candidates with proximal forearm perforator
- good inflow & outflow in screening
- vessels that can accommodate device & presence of perforator
In patient selection, the venous outflow must have the cephalic or basilic vein measure at least ___ in diameter
2.5 mm
In patient selection, the venous access options must have the ulnar or radial vein measure at least ___ window at the wrist
3 inch
In patient selection, the creation site must have:
proximal forearm ulnar and radial vessels
(T or F) only the bracial artery should be used for arterial access
True
access venous outflow: the direction of the probe when visualizing the perforator in long access can help identify _____ ______.
flow domiance
The device cannot create the EndoAVF through:
calcified vessels
In order to complete the screening the patient must have at least 1 radial artery and 1 radial vein greater than or equal to ____ in diameter.
2 mm
before the case you should scan the arm from the ____ point to the ____ point to note any anatomy challanges.
- access
-creation
patient requirements for EndoAVF:
- usuable cephalic or basilic vein for fistula outflow
- has patient perforator
- ulnar or radial artery and ulnar or radial vein greater than or equal to 2 mm in diameter
- bracial artery greater than or equal to 2 mm in diameter
the most important aspect of wavelinQ is:
patient selection
___% of fistulas fail to mature
36
creation/maintenance for WavelinQ:
2-3 procedures per year
3 parts of WavelinQ:
- selection/case planning
- creation/maintenance
- cannulation
for procedural ease, you want to:
- antegrade over retrograde
- use the largest vein at the access site
parallel procedure approach
access from upper arm
anti-parallel procedure approach
access fro wrist or upper arm
brachial vein access benefits
- larger vein to access
- arterial guidewire provides guide to venous wire
- can coil through existing venous sheath post-creation without crossing creation site
brachial vein access challenges
- wiring retrograde against valves
- accessing a deep vein
- avoiding the median nerve
ulnar vein access benefits
- accessing a superficial vein
- wiring with the valves
- straighter approach to endoAVF creation site
- good venography capabilities
ulnar vein challenges
- accessing a typically smal vein
- accessing from two different anatomical locations and directions
- coiling post creation
- navigating vessel anomalies due to past trauma
superficial vein access benefits
- working from similar access location as the arterial access
- accessing a large superficial vein
superficial vein access challanges
- wiring a retrograde against valves
- selecting the target vein at the base of the perforator
- coapting the device at the target lesion site
- coiling post creation
you want to reserve the future ____ _____ ____ for last resort
HD cannulation site
ulnar creation:
- usually larger
- our data supports it
- creation common ulnar under tuberosity
distal access advantages:
- valves
-perforator confirmation - hemostasis
distal access disadvantages:
- arterial injection
- marrying ulnar or radial after access
achieving “widest” or perpendicular flourscope view to the native vessel plane is critical to _____.
acurately aligning the devices
if gap is larger than 1 mm around the immediate electrode region, then_____.
reposition catheters prior to activation
indicators of false alignment:
- electrode is not compressed
- electrode appears behind the backstop
- no tissue gap evident
risks of false alignment:
- failure to form fistula
- extravasation/ psuedo
if catheters fail to align properly on the first attempt:
- fully disengage all magents by retracting a catheter
- perform venogram or otherwise adjust flouroscope to more perpendicular view
- consider relocating catheters to better postion
(true or false) catheters can still activate if greater than or equal to 50% of magnets are coapted
true
(true or flase) the wavelength 4F device may be activated up to 3x in a single procedure
true
why is it reccomended to embolize a bracial vein for patients with more than one bracial vein?
redirects flow superficially to help maturation
perform final fistulagram to ensure:
- efficient flow is diverted superficially
- EndoAVF is patent
- stable embolization placement
2 opportunities for cannulation:
- split flow AVF
- single vessel AVF
what is a bruit?
- vascular murmur, rumbling sound you can hear
- often heard therough a stethoscope as consistent swoosh or whistle
what casuses a bruit?
high pressure flow of blood through AVF
what is a thrill?
- rumbling sensation you can feel
- felt on overlying skin as a vibration
changes in bruit or thrill can indicate _____.
an issue (clot, narroing) of AVF
first week cannulation suggested needles?
17 gauge needles
second week cannulation suggested needles?
16 gauge needles
thrid week cannulation suggested needles?
prgoress to larger needles
overall how many petients were studied with either wavelinQ 6F or 4F EndoAVF system?
216 patients
4F global analysis pooled data set:
- 3 studies with combined 91 4F patients
- same inclusion/ excusion criteria
- same primary endpoints
Device related SAE for wavelinQ:
- 3.3% (3/91)
- 1 thrombosis of endavf
- 1 stenosis of endoavf
- 1 access of false aneurysm
procedure related SAE for wavelinQ:
- 5.5% (5/91)
- 2 endoAVF stenosis
- 1 access circuit hemotoma
- 1 access circuit false aneurysm
- 1 endoAVF thrombosis
what was the primary patency at 6 months:
72.4%
what is secondary patency at 6 months:
77.3%
What are Access options for Hemodialysis? (Select all that apply)
A) AV Fistula
B) AV Graft
C) Hemodialysis Catheter
D) EndoAVF
How long does it take for an Arteriovenous or AV Fistula to mature?
2-6 months
The most important aspect of WaveLinQ is:
Patient Selection
What are possible WaveLinQ EndoAVF access sites (Select all that apply)
A) Ulnar Vein
B) Radial Vein
C) Brachial Artery and Brachial Vein
Which vessel can be used for arterial access?
Brachial
WaveLinq Uses RF (Radio Frequency) energy to create a WaveLinQ EndoAVF?
True
Arterial closure devices are approved post procedure for brachial artery hemostasis
False
Which of the following qualifies a patient for an EndoAVF candidate (Select all that apply)
A) Good Inflow (Artery over 2mm)
B) Good Outflow (Superficial vein greater than 2.5mm)
C) Presence of a perforator over 2 mm
D) Adequate creation site
